23D-192 g 0lZeityib. , City of Northampton REQUIRED INSPECTIONS
BUILDING DEPARTMENT 1. Footings and Walls
• 2. Structural Components in Place*
3. Complete Building*
No. 1505 Office of the Building Inspector
Zoning Form No. 963446 Date 4/28/98 Fe�$20.00 Check# 2095
Page, 23D Parcel 192 ,Zone URB Section 127 ❑ Yes ® No
BUILDING PERMIT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Christopher Kouniotis before Building Inspections
has permission to strip & shingle roof Inspection on Site—Foundations
situated on 11 Baker Hill Road Inspection of Plumbing—Rough
provided that the person accepting this permit shall in every respect Inspection of Plumbing—Finish
conform to the terms of the application on file in this office, and to the Gas Inspection
provisions of the Statutes and the Ordinances relating to the Construction, Inspection of Wiring—Rough
Maintenance and Inspection of Buildings in the City of Northampton.
Any violation of any of the terms above noted is an immediate revocation Inspection of Wiring—Finish
of this permit.Expires six months from date of issuance,if not started. Building Inspection—Rough
Note:A certificate of occupancy will be issued by this office upon return Insulation Inspection
of this card signed by the Plumbing,Wiring and Building Inspectors.
Building Inspection—Finish
** Install per Manufacturer's information: windows, vinyl siding, roofs Smoke Detectors(Fire Department)
and woodstoves
Other
•
THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS PLACE ON 1)IE PREMISES
` .Certificate of Occupancy
Building Inspector
Liu
NJU � 1 FILE # 9 6 3 9 4 6 )605
FA-PR -2 3 '99�
1 APPLICANT/CONTACT PERSON:�1/ , Pe/,./72,1Z0 5/4 j?6`?
DEFT C, ADDRESS/PHONE:
PROPERTY LOCATION: // �G2- _1
MAP c79 3 C) PARCEL: 1 ZONE e_V_
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
7()N[NG FORM FTI LET) OUT
Fee Paid
Building Permit Filled nut ) 5 o
Fee Paid
Type of Onzctrnrtinn•
New f nnctrnrtinn � i '/`�
Remodeling Interior
Addition hi FYicting
L'frri-6
Are ccnry Struetnre
Rnildin Plane Tnrinded•
cOy
w �Orenrant Statement nr T,irence#
Sete of Plane /Plot Plan —
TLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
Approved as presented/based on information presented
/ Denied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received&Recorded at Registry of Deeds Proof Enclosed
Finding Required under:§ w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Variance Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
14. * ' .6 - `d of Health Well Water Potability-Bd Health
4
4tfroConommissi
'AIT.°°. , ,41 Y/455/,e5
Signature of Building tor Date
NOTE:Issuenoe of a zoning permit does not relieve an applioant's burden to oomply with all
_ zoning requirements end obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applicable permit granting authorities.
l i - -1 (0 (r
APR 2 DEFT O 3 i998 iLL) ,,
-f d-r U.LC,lbi:9,G.INSPECT 0 S Fi 1 e No. 9l0 �� 1
NORTHAMPTON,MA 01060 n
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE ,,TYPE OR PRINT ALL INFORMATION
�. Name of Applicant: r�(i96'Y SIG�'�i! ,. k�Z�) ,i-
Address: 1/ /S' .-- z- /1/// i2i Telephone/ `///). 7 9�
2. Owner of Property: �Yr.) (
Address: Telephone:
3. Status of Applicant: X Owner Contract Purchaser Lessee
Other(explain): A,,�
4. Job Location: // ,Fal f �'�i$ •
Parcel Id: Zoning Map# 023 D /9d District(s): �i��
Parcel#
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property sJ/
...y/
6. Descriptii9n of Proposed U IWork/P;oject/9ccupation: (Llse additional,ss,eets if necessary): •
'5/ -J� / k /-r7661iP�/e koc) of GG 24-c-
7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans
Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files.
8. Has a Special PermitNariance/Finding ever been issued for/on the site?
NO DON'T KNOW YES IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document#
9. Does the site contain a brook, body of water or wetlands? NO .1 DON'T KNOW YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained ,date issued:
(FORM CONTINUES ON OTHER SIDE)
10. Do any signs exist on the property? YES NO
IF YES,describe size,type and location:
Are there any proposed changes to or additions of signs intended for the property?YES NO V
IF YES,describe size,type and location:
11 . ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This column to be filled in
by the Building Department
Required I
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - frnnt
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
' &pawed parking)
# of Parking Spaces
?It Loading Docks
Fill: -
(volume -& location)
13 . Certification: I hereby certify that the information contai d h rein
is t e and accurate to the best of my knowl e.
DATE: 4/! .-'-/ �
APPLICANT's SIGNATURE
NOTE: Issuance of a zoning permit does not relieve an appli s burden to oompiy with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applioable permit granting authorities.
FILE #
o4oToy .�5��7 U��, •
e�.w`'�►.�'�,,,:' 1� •y (set of ox arpthnt 1 _'t om
a= `�"_�N a APR 2 3 OqR / L lasaarlinsetta =::, .
"".m-� 3 ,-..,I DE ARTMENT OP BUILD1TtG INSPECTIONS 4 __`
ci : N'S -•
1;;11 r, : , ^ ;i 2 2 Main Street ' Municipal Building =_
Northampton, Mass. 01060 '�� `r
WORKER'S COMPENSATION INSURANCE AFFIDAVIT 1
clipermittee)
with a principal place of business/residence at:
L/ a,, /11/ kWt (phone#)(Li j `-fsiz--,,.5
(street/city/state/zip)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
(Insurance Company) (Policy Number) (Expiration Date)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
•
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additieml sheet if nei-a-m ry to include information pertaining to all contractors)
( ) I am a sole proprietor and have no one working for me.
(4 I am a home owner performing all the work myself.
NOTE:please be aware that while homeowners who employ persons to do tn.mtrnarur,construction.or repair work on a dwelling of
not more than three units in which the hoioowncr resides or co the grounds appurtenant thereto are cot generally ooaridcrod to be
emp1oyrra under the worker's em>pn+sat ice.Act(GL152,ss 1(5)),application by a homeowner for a license or permit may evidence the
legal status of an employer under the Worker's.Compensation Act
I understand that a copy of this sutement may be forwarded to the Department of Inehtslrial Accident(Offioe of Insurance for the
coverage verification and that failure to secure coverage under section 2.5A of MGL 152 can lead to the unposidoe of criminal pcaalt es
eoosisting of a fine of up to S 1,500.00 and/or impaisonnxut of up to one year and civil penalties in the form of a Stop Work Order and a
fine of 5100.00 a day against me.
For dcpratmental use cot'
9%S/� Permit Number
MAO Lot#
y"` Si LiccnseefPcrmitt e Date
�.+�MlY•�............ ......tee y.t.. —
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4 qiik of Northampton „..
..,,:" t—�-Y APR 2 3 r`�{ DEPARTMENT OF BUILDING INSPECTIONS __� ,
INSPECTOR 212 Main Street ' Municipal BuildingNorthampton, Mass. 010607wi.t._.......
'` ``
J
HOMEOWNER LICENSE EXEMPTION .
�4 /' (Please Print)
DATE: / q ��
JOB LOCATION: /j p - / �" .4 � e .__
(Map L(,Parcei-l) (Subdivision)
HOMEOWNER:-J (L./'I Stalk, i �Lr)/d/i
j'(N e & Address ),
%/ e,�41_, /''/ yid) '�. z57 ( `f/1)` S I//
(Home Phone) (Work Phone)
The current exemption for "homeowners" was extended to include
Owner-occupied Dwellings of one ( 1 )or two (2) families and to allow such
homeowner to engage an individual for hire who does not possess a '
license, provided that the owner acts as supervisor . CMR780 Section 109. 1 . 1
DEFINITION -OF HOMEOWNER: Person(s) who own a parcel of land on
which .he/she resides or intends to reside, on which there is, or is
intended to be, a one or two family dwelling, attached or detached
structures accessory to such use and/or farm structures . A person who
constructs more than one home in a two-year period shall not be
considered a homeowner. Such "homeowner" shall submit to the Building
Official, on a form acceptable to the Building Official, that he/she
shall be responsible for all such work performed under the building
permit.
As acting Construction Supervisor your presence on the job site
will be required from time to time, during and upon completion of the
work for which this permit is issued. O
Also be advised that with reference to Chapter 152 (Workers '
Compensation) and Chapter 153 (Liability of Employers to Employees for
injuries not resulting in Death) of the Massachusetts General Laws
Annotated, you may be liable for person( s) you hire to perform work for
you under this permit.
'The undersigned "homeowner" certifies and assumes responsibility
' for compliance with the State Building Co e, City of Northampton
Ordinances, State and Local Zoning La , State of Massachusetts
General Laws Annotated.
HOMEOWNER SIGNATURE
BUILDING PERMIT # .
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
iiko.%r NORTHAMPTON, MASS. 19 Additions
F APPLICATION FOR PERMIT TO ALTER Repair
'' /� Garage
4. Location /7 ��4,�-�!t- `"/" 1-t(
/� -� /, Lot No.
2. Owner's name C //S4t2 L ✓ ' 4-�Ezl J�( Address I/ /S z k& /i /
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration
6. New Porch
7. Is existing building to be demolished?
8. Repair after the fire
9. Garage No.of cars Size
10. Method of heating
11. Distance to lot lines
12. Type of roof S i-i , lr W /i `_1 iv5l y'S
13. Siding house / ✓
14. Estimated cost:- Wv -U()
The undersigned certifies that the above s men are true to the best of his, her
knowledge an ief.
ignature of responsible applicant
Remarks